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LOJN'L>0> : 

In the following Essay the writer has endeavoured 
(he trusts not altogether without success) to clear 
up a subject which he has long felt much needed 
clearing. If anything further were required to show 
how great the need was, a passage from Dr. Lewis 
Shapter's Presidential Address on The Science of 
Medicine, just delivered before the South Western 
Branch of the British Medical Association, would 
amply suffice. In this passage the terms " work," 
" science/' "art," " practice," are used so confusedly 
that it is impossible for the reader to distinguish 
any difference iu their meanings. Dr. Shapter 
said : — 

" When we regard medical work as involved in a true science, we 
must look to ourselves as units amidst a great concourse of actors, 
taking our place amidst a vast concourse, whose object is to strive 
to advance a general art — the prevention, alleviation, and cure of 
disease ; and the branches of practice into which the art may be 
disseminated must only be regarded as means to produce this 
general end. This is the ti-ue and full meaning of the ' practice of 
medicine ' as a ' science ' " (British Medical Journal, July 5th). 

This is confusion worse confouuded. 

In the final shaping of his thoughts the writer 
wishes to acknowledge the assistance he received 
from a study of Mr. Buskin's volume of Oxford 
Lectures entitled The Eagle's Nest. 

15, St. George's Teerace, 

Gloucester Road, S.W. ; 
July, 1884. 



The confusion of ideas that prevails throughout the 
medical profession as to what is science, and what is art, 
and what are the right relations between the two, could 
hardly he better illustrated than by placing side by side two 
sentences extracted from one of the medical journals of last 
year. In March, 1883, the Medical Times and Gazette 
said : " Marwood appears to have reduced his calling to a 
science : " — and in December of the same year : " The fact 
is hanging is not a science but an art, and is better done by 
rule of thumb than by theory. " Among the many baseless 
assumptions contained within the narrow limits of this mar- 
vellous pair of sentences three stand prominently forth. 
The first is the assumption that it is quite possible to convert 
an art into a science. Next, it is assumed that a science 
as well as an art is concerned with action. And, lastly, 
the distinction between an art and a science is assumed to 
be that the former is governed in its operation by rule 
of thumb and the latter by theory. 

This confusion is not by any means confined to the 
medical view of the gruesome function of the common 
hangman — a function which the soaring ambition of the 
Students' Journal would fain include within the duties of 
the professor of life-saving — it affects the whole domain 
of medical thought " Hitherto," says the Lancet * [sur- 
gery] has been too much of an art, too little of a science." 
w Before therapeutics " — the art of Healing, proper, — " can 
become a science/' says Dr. Lauder Brunton,f " the 
physician must know the action of his drugs, just as the 
locksmith does that of his keys, and since pharmacology is 
* Jan. 5, 1884. t Pharmacology and Therapeutics, p. 66. 

still so young, it is little wonder that medicine is as yet 
only an art : " — here the conversion of the art of Healing 
into a science is assumed to depend on the perfecting of 
our knowledge of the action of drugs. Until this is 
accomplished, Therapeutics must remain "only an art." 

The confusion of thought betrayed by these quotations — 
and they might be multiplied ad infinitum — would be 
ridiculous, simply, were it not fraught with such lamentable 
results to medical teaching and medical practice. The 
unreflecting mind of the medical student being impressed 
from his first entrance on his studies with the notion that 
art and science are convertible things, and that science is 
immeasurably superior to art, he soon learns to despise 
what is " only " an art, and cleave to everything that has 
the appearance or reputation of being scientific. The 
energy and devotion which should be spent in acquiring 
skill in the practice of his art are squandered in vain 
endeavours to find scientific explanations of the inexplicable ; 
theories that shall satisfactorily dispose of the mystery that 
underlies all the phenomena of life, in health and in 
disease. Until this desirable end has been attained, the 
doctor's function must remain "only an art;" and the 
student and the practitioner need not expect to be able to 
do very much for their patients. 

Needless to say, all this is folly unutterable. Science 
is science ; and art is art. The two, though closely related, 
are absolutely distinct — as distinct as the clay is from the 
potter who uses and fashions it. Science is knowledge — 
the knowledge of facts duly ordered in their right relations. 
Art is action — the skilled performance of right acts. 
Knowledge may be imparted: practical skill can only be 
acquired by rigid self-discipline and patient exercise of 
natural powers, No perfection in knowledge will ever do 
away with the need of artistic skill in applying it : action 
will never be knowledge nor knowledge action to the 
world's end. 


Partly accounted for by this confusion of thought, and 

partly, also, accounting for its continuance, is the loose and 
indefinite use that is made of the term medicine. Now it 
is used to designate the whole domain both of medical art 
and medical science ; now it is used to express all that 
concerns the natural history of disease except its modifica- 
tion by treatment. When the special function of the 
medical man — the treatment and cure of the sick — is 
wished to be indicated, the term medicine is rarely used, 
but another, therapeutics, is employed instead. So far, 
indeed, has the idea of curing been dropped from the term, 
that the etymologically ridiculous phrase of tc preventive 
medicine," as applied to sanitation, now startles no one. 
In this essay I shall avoid the term altogether. I shall 
speak of the doctor's art and the doctor's science. I use 
the term " doctor " generically as covering the whole ground 
occupied by physician, surgeon, and midwife. The func- 
tions of all these are often combined in a single practitioner; 
the distinction between them is one of convenience merely, 
not of essence. 

The art of the medical practitioner is made up of two 
arts. Of these, one is the art of Healing, proper. This 
consists in the skilled appliance to the sick of those means 
which are capable of so modifying disordered conditions of 
the organism as to bring about cure or relief. The other, 
quite distinct from this, is the art of Distinguishing, or, as 
it is commonly called, Diagnosis.* This is the art of 
recognising disordered states of health and of determining 
the nature of these disordered states. 

Each of these arts is based on a distinct science. 

The science on which the art of Healing is based consists 
in the knowledge of the powers possessed by all the various 
means and substances which are capable of curing or reliev- 
ing diseased persons. 

The science on which the art of Diagnosis is based con- 

* I use the term diagnosis in its widest sense. I include under it dis- 
tinguishing between states of health and states of disease, and distinguishing 
the different states of disease from each other. I include, also, distinguishing 
the nature and gravity of any given state of disease, and determining its 
probable duration and issue. Prognosis, or forecasting, is really only a branch 
of diagnosis. 

sists in the knowledge of the constitution of the human 
body in health and in disease : a knowledge of all the 
varied disturbances which the body undergoes in disease, 
and of the natural history of these disturbances. 

These two arts — Healing and Distinguishing — sum up the 
functions of the medical man. It is for the performance 
of these alone that his calliug exists ; it is these alone 
which give the distinctive character to his life in the State. 
Whatever other functions be may have had imposed upon 
him, or may have taken upon himself, these are not proper 
to him as a medical man. In order to carry out his func- 
tions efficiently it is necessary for him to know the sciences 
on which the arts are based ; but it is not the knowledge 
that gives him his distinctive character ; it is the practice of 
his arts — the skilled application of his knowledge — that 
makes him a doctor. 

I have said that these two arts — Distinguishing and 
Healing — and the sciences on which they are based, are 
entirely distinct. I will endeavour to make this plain. A 
doctor is called to a patient suffering from ague. By virtue 
of his knowledge of the constitution of the body in health 
and disease he is able to distinguish by the symptoms 
manifested the nature of the patient's malady and to fore- 
cast the result. But having done this with perfect success, 
he would never by this means have discovered the power of 
Cinchona Bark to quell an attack of ague. This is an alto- 
gether different kind of knowledge, and the application of 
it an altogether different art. By some happy accident the 
power of Bark over ague was discovered by the dark-skinned 
natives of Peru : there was nothing in the ague-fit to sug- 
gest that Bark possessed this power. Ague had been dia- 
gnosed for centuries, but diagnosis had never suggested the 
power of Arsenic or Cinchona to cure. By the use of 
Cinchona in ague its powers over the disease and the limits of 
those powers have been more or less accurately defined. 
The knowledge of those powers constitutes the science of 
Healing so far as this drug is concerned in its relation to 
this disease. The art of administering the drug in suitable 
doses, at proper times, in accordance with all that is known 

of its powers, is an altogether different art from that of 
recognising the disease. The two arts must be combined 
in the medical man : he must be able to answer, What is 
wrong ? as well as, What is to be done ? Usually — but not 
by any means always — he must answer the first before he 
can answer the second. But though thus intimately con- 
nected, the two arts are in nature and essence distinct. 

I have said that in order to practise his double art suc- 
cessfully, the doctor must know the two sciences on which 
his art is based. In this I have expressed the relations 
that rightly obtain between science and art, and conse- 
quently between the sciences that the doctor ought to know 
and the arts which he practises. The knowledge of the 
characteristic symptoms of ague is oue thing ; — this is the 
science of Diagnosis : the skill exercised in observing these 
symptoms in a given patient, in distinguishing them from 
the symptoms of other diseases, and in determining their 
gravity and import is quite another thing; — this is the art of 
Diagnosis. The knowledge of the power of Bark to extin- 
guish an ague-fit, and in certain cases to cure the disease, 
is one thing ;— this is the science of Healing : the skill 
required to prescribe the drug in right doses at right times 
is quite another thing ; — this is the art of Healing. By no 
conceivable — or inconceivable — process can the knowledge of 
the conditions to be dealt with — science — be converted into 
skill in dealing with the conditions — art. The function of 
the medical man is an art : — yes; "only an art." So it has 
been since the days of Hippocrates and before him ; and so 
it will be to the end of time. It is his duty to know a 
great deal before he can profitably discharge his functions ; 
and this knowledge is his science. But much as he may 
know, however learned in his science he may be, unless he 
has by patient exercise and cultivation of his powers 
acquired practical skill in relieving the sick, he is not a 
medical man at all — he is a scientist merely, not an artist. 

A patient of mine, himself an artist and well able to 
appreciate artistic qualities^ has at different times had to 
undergo a painful surgical operation. The operation has 
been performed by surgeons of the highest eminence^ first 


by the late Sir W. Fergusson, and afterwards by a surgeon 
now living. The conditions under which the operation was 
performed on the two occasions were as nearly as possible 
exactly alike. In point of scientific attainment there was 
nothing to choose between the two operators. But my 
patient tells me that nothing would induce him to put 
himself a second time into the hands of the surgeon who 
operated after Sir W. Fergusson : — the operation by the two 
men was quite a different thing. In the hands of Sir 
William he felt at once that he was in the hands of an 
artist : the very touch of the other was quite different from 
his : the amount of pain caused by the two surgeons was out 
of all proportion. Now, wherein lay the difference ? Was it 
in knowledge of anatomy, physiology, and all the other 
sciences supposed to be necessary for the medical man to 
know that Sir William was superior to the other ? The 
mention of the other's name would at once negative such a 
supposition. The difference lay here — Sir William was an 
artist. By patient cultivation of his natural powers he had 
acquired a skill which the other did not possess, and which 
no degree of proficiency in science could make up for. 

Do not let it be supposed that I object to scientific 
medical practice. The practice of Sir William Fergusson 
was more scientific than that of the other, not because he 
knew more, but because he had mastered the art of putting 
in practice what he knew. His work was in stricter con- 
formity to the conditions to be dealt with. He who knows 
accurately all that can be known of the human frame in 
health and in disease, and who, acting on this knowledge, 
applies his skilled powers in distinguishing the diseased 
conditions in a given case — this is a scientific practitioner. 
He who knows all that can be known of the powers of 
remedies over diseased conditions, and who, acting on this 
knowledge, brings skilled power in the use of these 
means to the service of the sick — this is a scientific 

But this is not what is usually regarded as deserving the 
name scientific in medical affairs. What is so regarded was 
clearly shown at a meeting of the Materia Medica Section of 

the International Medical Congress of 1881. At the close 
of a discussion in which a number of physicians of experience 
had brought forward important facts observed by them in the 
treatment of disease, the President, Prof. Fraser, of Edin- 
burgh, made a few observations. He said that the remarks 
of the speakers, with one exception, had not come up to the 
scientific level of the day. The one speaker who was thus 
honourably excepted was Dr. Murrell, who had spoken of the 
behaviour under the action of different drugs of the hearts of 
frogs cut out of their bodies ! Now, until it is determined 
what relation exists between the excised heart of a froar and 
the heart of a human being in the body, this is not medical 
science at all : it helps the medical man no whit in disco- 
vering what is wrong with his patient, nor in putting that 
wrong right. This is solemn trifling ; and, like the tubes 
full of coloured fluid which the market-place quack gives 
his dupes to hold that he may divine from the movements 
he observes what malady possesses them, these experiments 
on excised frogs' hearts serve only to inspire those who — 
like Prof. Fraser — ought to know better, with an idea of 
the scientific eminence of those who perform them. 

Nor — in spite of the Medical Times — is theoretical practice 
scientific. The germ theory of disease is not the doctor's 
science. Until it is proved what share micro-organisms 
have in disease-processes, they afford no ground for the 
medical man to work on, whatever interest they may have 
for the biologist. When Vulpian, acting on the assump- 
tion that the germ-theory is true, seeks to kill the microbe 
of typhoid fever in his patients suffering from that disease, 
he is not acting on known but on supposed conditions ; his 
practice is not scientific but theoretical : and when, 
instead of the microbe, he poisons his patients, the badness 
of his art — and of all such art — is made apparent. And 
when Dr. Burdon Sanderson* says that the title of " Insti- 
tutes of Medicine " — that is, the foundation of the doctor's 
art — " does not properly belong to the science which deals 
with the workings of the human body," but " really 
belongs to another branch of scientific inquiry, that which 

* Inaugural Address at Oxford, Lancet, Oct. 20, 1883. 


consists of the experimental investigation of the nature and 
origin of diseases, and of the external agents which either 
produce or counteract them," he only shows that he is 
completely ignorant of the proper relations between science 
and art, and of what scientific medical practice really is. 
The practice which is based on an " inquiry " instead of on 
known facts is experimental and not scientific. Professor 
Vulpian's results are a significant comment on Dr. Burdon 
Sanderson's wonderful doctrine. 

Again : the doctor's science does not lie in an extensive 
acquaintance with mongrel Greek and Latin words and 
scientific phrases. When the editor of the Lancet* tells us 
that a It is sometimes forgotten that coughs (sic) — pro- 
perly so-called in their integrity — are convulsive, expira- 
tory efforts intended to eject from the air-cells or passages 
of the lungs, or from the windpipe or larynx, either secre- 
tions or exudations, or, occasionally, foreign substances, 
which impede the act of respiration," we are not to infer 
that he is unusually scientific in his treatment of coughs, 
but only that he has a great facility for saying in learned 
jargon what everyone knows, to wit, that coughs are — 
coughs. Nor was that an eminently scientific practitioner 
who told a lay friend of mine to whom he was relating the 
particulars of a race-accident at which he had assisted, that 
an unfortunate person had sustained a fracture of the 
clavicle, adding, " 7 here are three thirds in the clavicle, you 
know, and this took place in the middle one ! " I can 
match these two, in scientific value, with the saying of an 
old dame who came to my hospital clinic. She wished to 
consult me about her daughter whom she had brought. 
I asked her if the patient had lost flesh since her illness 
began ; upon which she broke out with this : " O, no ! 
Sir. I only wish she had ! // doesn't play on the constitution 
if it touches the flesh /" The worthy old lady had observed 
a fact, — or had imagined she had, — and she translated that 
fact — or supposed fact — into theoretical and, as far as she 
knew how, scientific language. In other circumstances she 
might have edited another Lancet with no little success. 

* Dec. 15, 1883. 



It is sometimes said that the science of medicine is made 
up of many sciences — physics, chemistry, botany, zoology, 
normal and abnormal anatomy and physiology, and materia 
medica. This is not the case. The science needed by the 
medical man partakes of these sciences to a greater or less 
extent, but it is not identical with any or all, and it in- 
cludes many things of which these take no note. Now 
that the doctor no longer collects his own herbs he makes 
no use of botany in his practice, however desirable it may 
be for his intelligence that he should know it : the botanical 
characters of a plant are altogether different from its powers 
over the human body. Again, however necessary it may be 
for a professor of physiology to know all the various theories 
advanced to explain Development, this knowledge is of little 
service to the doctor when he comes to the bedside of the 
sick. What it is necessary for him to know is, the facts of 
anatomy and physiology — morbid and healthy — so far as to 
be able to form a true conception of the condition of his 
patient, and to know the external conditions that are cap- 
able of influencing him either for good or evil. This is the 
twofold science the medical man needs to enable him to 
practise his twofold art with success. 

Imagine a modern neophyte placed by the side of a sick- 
bed along with Sydenham in his prime. The latter would 
not be able to pass a modern examination in elementary 
science ; he would be a stranger to the atomic theory and 
the germ theory alike ; he would know nothing of bathy- 
bius, protoplasm, embryology, or evolution : and yet, what 
sane person would not prefer Sydenham's opinion as to the 
state of the patient, the gravity of the case, and the likeli- 
hood of recovery to that of the modern tiro ? True, he would 
not, if the case were obscure, be able, like the latter, to 
utter with an air of profundity the words " neurosis " or 
11 vaso-motor "\ and he might not give the condition the 
name by which it is now generally known ; but in all the 
essentials of the diagnostic science and art he would be 
immeasurably the other's superior. In regard to the art of 


Healing there might not be much difference. Treatment 
has always been founded almost entirely on theories of dis- 
ease, and Sydenham, doubtless, often lessened his patient's 
chance of recovery by employing blood-letting on the suppo- 
sition that it was necessary to employ an " antiphlogistic ": 
but Sydenham did not poison his patients with carbolic acid 
under the impression that he was killing microbes. 

I said it was necessary for the doctor to know the facts 
of anatomy and physiology. Here is the point where a 
great deal of the confusion begins. The object of the 
student of science is to get at facts through phenomena. 
This is right and necessary. The mistake made by modern 
teachers in the medical schools is, that they do not recognise 
what are the facts with which we must be content. In all 
the concrete sciences, and especially the sciences which deal 
with life, the ultimate fact of any phenomenon, or group of 
phenomena, we can never reach. In physics we may 
recognise the existence of the force of gravity, but we must 
acknowledge that the force itself is a mystery to us. In 
all the sciences which are concerned with living things the 
complexity is much greater. There is a factor which we 
can never fully estimate ; and until we are honest with our- 
selves and acknowledge this to be so, we must inevitably 
fall into error. At this point medical thought divides into 
two streams. One set of thinkers deny the existence of 
any such unmeasurable factor. " There is no more mystery 
in living bodies than there is in a steam-engine," said a 
teacher of physiology to his class not many months ago. 
The other class, recognising the existence of the unknown 
force, think that since it is unknown and not to be weighed 
and measured, they may in their calculations ignore its 
existence. Both sets of thinkers are illogical and un- 
scientific. There is a difference between a piece of living 
protoplasm and the same protoplasm the moment life has 
left it. Until men of science have explained what that 
difference is, it is folly alike to deny or ignore its existence. 

But if the life-force is unknown in its essence it is not 
unknown in its manifestations. We have these for our 
guidance, and these constitute the basis facts of our science. 


It would be much more satisfactory to the scientific type of 
mind if the explanation of these facts were to be reached ; it 
would be much more satisfactory if we could see all that 
takes place in the inner workings of the economy when a 
person takes cold ; but, uutil the mystery of the invisible 
life-force is solved, the phenomena are themselves our facts : 
the chill, the fever, the catarrh, the malaise, — the knowledge 
of these constitutes our science. If we frame an explana- 
tion of the inner power, and then prefer our explanation to 
the phenomena sought to be explained, we are not scientific 
but the reverse. And again, if we are not content to know 
that certain drugs have certain powers over different parts 
of the body, but must wait until we have found some theory 
satisfactory to ourselves of their peculiar power and affinity 
before we use them, we are not following the dictates of 
true science. And yet the search for these explanations of 
the inexplicable are now regarded as the highest aim of what 
is called medical science. It is this that is leading men to 
perform dreadful experiments on living animals, although 
they differ in unknown ways and degrees in their anatomy 
and physiology from man. It is these that are held up to 
the student for his admiration as constituting genuine 
science and the glory of the medical profession. 

And what is the result of this teaching ? I happen to 
be able to gauge it pretty accurately in my own case. In 
my pupilage, before joining my university, I remember 
that I had an idea that the purpose of my life was to be 
the healing of the sick. In a small way, I felt that I was 
able to do something of the kind, even at that early stage, 
under the eye of my elders. I had a notion, also, that the 
limited extent of my powers was chiefly due to the fact 
that I could only in a very slight degree understand the 
phenomena that came before me. I could recognise a 
number of disorders, but I did not understand the rationale 
of them. I thought that when I should attain to this it 
would enable me to do much more for my patients. 

A few years later I was present at a meeting of a society 
of medical students of which I was a member, where a 
paper was read on the subject of " Therapeutics." By dint 


of much study, I had, by this time, become fairly proficient iu 
a number of sciences, and I can measure the effect the teach- 
ing had had on myself by remembering the astonishment, 
which I shared with the majority of those present, when 
the reader of the paper made this remark : " After all, 
therapeutics — the curing of his patients — is the chief end 
of the doctor's calling." — I had come to believe that the 
chief end of the doctor was to be able to give a scientific 
explanation of anything and everything connected with the 
sick ! 

Another result of the exaltation of what is supposed to 
be science in the course of medical training is seen in the 
newly-qualified when first thrown on their own resources. 
Most men, I take it, will remember experiencing at that 
moment — unless a long course of post-graduation practice 
in house-surgeonships have given them confidence — a 
dreadful sense of helplessness,* which only diligent exercise 
of their faculties in dealing with the sick has sufficed to 
wear off; and the exigencies of life, — the responsibility which 
cannot be escaped, — if no higher cause, soon compel this 
diligence. But when the newly-qualified accepts some 
subordinate post, where responsibility is reduced to a mini- 
raura, the real effects of the glorification of science in 
medical training is more plainly exhibited. The word you 
most frequently hear from him is the word " interesting/' 
His work is " interesting ;" the cases are " interesting ;" a 
very dangerous case is " extremely interesting ; " it affords 
boundless scope for his highly developed talent for weaving 
explanatory theories — the chief aim of his life — with the 
result of which, however, patients are ungrateful enough 

* This is not always the case, as an incident related to the writer will serve 
to show. A licentiate of a northern medical college of no very high repute, 
the day after his " qualification " had heen conferred upon him, appeared as 
formerly in the hospital wards in the train of the clinical professor. The 
latter, forgetting the mystic change that had come over the youth within the 
previous twenty-four hours, questioned him as usual about the cases, and, as 
usual, when he made a foolish mistake, rebuked him with professorial severity. 
Stung to the depths of his professional pride, the new-born licentiate floored 
his professor with this retort: "Well, 1 think I may be allowed an opinion, 
seeing I am now a qualified man 1 " 


not to be satisfied. Happily, the seniors under whom he 
works have had their feeling of " interest " in the cases 
mastered by another sentiment ; and when our neophyte 
comes to solicit the favours of a suffering public, he himself 
soon finds that the interestiugness of his patients is not the 
main consideration. 

But though his manner of regarding and dealing with 
patients undergoes a radical change under the wholesome 
pressure of responsibility, his belief in his powers of curing 
them does not, as a rule, grow stronger. When a patient 
asks to be cured the reply of Young Physic is this : My 
dear fellow, do not be unreasonable ; we know a great deal 
more about your disease than we did formerly ; we can tell 
you exactly what centres are deranged — at least, we think so 
— and " we must be able to avert " your disorder better next 
time ; we must " tend to treat diseases better " — and your 
disease among them — " if any such action be possible." I 
am not going to give you drugs ; you have had the com- 
fort of having your disease explained to you most scientifi- 
cally. Unfortunately our pharmacologists have not yet ex- 
plained drug-action satisfactorily, and the scientific physician 
"wants a reason why, before he gives a drug." "The 
monition of the best medicine of to-day " is : " Amend the 
life according to biological laws, repent of physiological 
transgressions, and throw physic to the dogs." These are the 
sentiments of Dr. H. Donkin, expressed in an introductory 
address delivered by him at the London School of Medicine 
for Women in October last.* This is the hopeful — and 
natural — outcome of the teaching which regards theoretical 
explanations of drug-action and disease as of greater scientific 
importance than the facts. 

So far from this being genuinely scientific teaching it is 
the very negation of science. It would be as wise on the 
part of a natural philosopher to disregard the phenomena 
connected with the force of gravity until he had satisfac- 
torily explained what that force was, as it is for the physician 
to refuse to utilise the powers of drugs uutil he has found 
an explanation of them satisfactory to himself. It is 

* 3Iedical Times and Gazette, Oct. 6, 1883. 


impossible to conceive the difference it would make to 
medical practice if students were clearly shown that their 
business in life is to be not scientists, but practitioners of 
an art ; that their art must always keep on a level with 
their science — their knowledge never be too great for them to 
be able to utilise ; that as practitioners of medicine, physio- 
logical and pathological investigations, apart from clinical and 
post-mortem observations, are no business of theirs; that all 
their scientific acquirements are only valuable — apart from 
any beneficial influence they may have on their general intelli- 
gence — in so far as they minister to their understanding 
of their own peculiar science — the knowledge of the con- 
stitution of the human organism and all that can influence 
it for good or evil. The true end to set before students 
is the acquirement of an art. They should be shown that 
this depends altogether on themselves ; that the condition 
on which they may have it is—patient, self-denying, honest 
practice. And not only is this the sole way of their 
acquiring proficiency in their art, it is the only true way 
of advancing their proper science. Art always has pre- 
ceded science, and always must. The men who have done 
most for the science of the medical practitioner are those 
who have most devotedly cultivated his art. Who has 
served the cause of science best, Trousseau or Claude 
Bernard ? Jonathan Hutchinson or Burdon Sanderson ? 

The medical practitioner is an artist first and last. He 
is only a scientist in so far as science ministers to the 
practising of his art. The twofold art he professes is a 
noble art. The very difficulties that beset the attainment 
of proficiency in its practice confer on it nobility by the 
qualities called out to surmount them. There is no royal 
road. The scientists, with their explanations and simpli- 
fyings, have not yet succeeded, and never will succeed, in 
reducing the doctor's art to something like the working of 
a Babbage calculating machine. This is what they seem 
to mean when they talk of " reducing" — or M elevating" — an 
art to a science. In spite of all their efforts — let Science 
advance to what height of sublimity she may — they will never 
succeed in turning out into the world ready-made Syden- 


hams after a four or five years' course of study. Sydeuhams 
are uot made iu the schools ; they are made by their own 
honest, unpretentious, self-devoted practice of the art they 
profess. The true function of the schools is to put the 
students in the way of doing this; to show them that on them- 
selves depends whether they succeed or fail ; to encourage 
them manfully to meet the difficulties that beset their 
endeavours to render themselves helpful and efficient at the 
bedside of the sick. A few years of work of this kind will 
confer no mean degree of proficiency in his art on him who 
gives himself up to it, and will lay the only foundation for 
future advance. Perfect mastery in this art of arts a whole 
lifetime is too short in which to attain. The devotion of a 
life is not enough to confer this ; and nothing short of a 
life's devotion is demanded for the acquirement of high 
proficiency. The dilettante has no place among the worthy 
professors of the Doctor's Art : 

" The track our venturous keel must furrow brooks 
no self-sparing pilot."